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García-Rudolph A, Wright M, García L, Sauri J, Cegarra B, Tormos JM, Opisso E. Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation. J Spinal Cord Med 2024; 47:649-660. [PMID: 36913541 PMCID: PMC11378684 DOI: 10.1080/10790268.2023.2183326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
CONTEXT Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. OBJECTIVES (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. METHODS This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. RESULTS The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay. CONCLUSIONS Discharge FIM items accurately predict long-term functional independence.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mark Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Loreto García
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Sauri
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Maria Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Kim SS, Kim OY, Kim SH, Heo JE, Ho SH, Kim JH, Bae YH. Correlations between ADL in patients with SCI and caregiver burden, quality of life, and presenteeism in South Korea. Sci Rep 2024; 14:3081. [PMID: 38321052 PMCID: PMC10847127 DOI: 10.1038/s41598-023-50559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
The correlations between activities of daily living (ADL) among patients with spinal cord injury (SCI) and their caregivers' burden, quality of life (QoL), and presenteeism was investigated. Participants included outpatients and inpatients with SCI at a rehabilitation center and their caregivers, recruited between March 2020 and April 2021. Eighty-seven valid responses were analysed using independent t-tests and Pearson's correlations. There was a difference in caregiver burden according to patients' ADL performance. QoL was negatively correlated with caregiver burden and presenteeism. Caregiver burden and presenteeism were positively correlated. Social support can improve caregivers' QoL and reduce caregiver burden and presenteeism-induced work impairment.
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Affiliation(s)
- Sung Shin Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, Republic of Korea
| | - On Yoo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Republic of Korea
| | - Sun Hong Kim
- Department of Nursing, National Rehabilitation Center, Seoul, Republic of Korea
| | - Jae Eun Heo
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Seoul, Republic of Korea
| | - Seung Hee Ho
- Department of Healthcare and Public Health, National Rehabilitation Center, Seoul, Republic of Korea
| | - Ju Hee Kim
- Department of Healthcare and Public Health, National Rehabilitation Center, Seoul, Republic of Korea
| | - Young-Hyeon Bae
- Department of Healthcare and Public Health, National Rehabilitation Center, Seoul, Republic of Korea.
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Collins J, Lizarondo L, Taylor S, Porritt K. Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review. Disabil Rehabil 2023; 45:3435-3455. [PMID: 36299236 DOI: 10.1080/09638288.2022.2133180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process. IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.
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Affiliation(s)
- Jeanette Collins
- JBI, University of Adelaide, Adelaide, Australia
- Jeanette Collins, Rehabilitation in the Home (RITH), Perth, Australia
| | | | - Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
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Guízar-Sahagún G, Grijalva I, Franco-Bourland RE, Madrazo I. Aging with spinal cord injury: A narrative review of consequences and challenges. Ageing Res Rev 2023; 90:102020. [PMID: 37487887 DOI: 10.1016/j.arr.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.
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Affiliation(s)
- Gabriel Guízar-Sahagún
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico.
| | - Israel Grijalva
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
| | - Rebecca E Franco-Bourland
- Department of Biochemistry, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 289 Calzada México-Xochimilco, Mexico City, Mexico
| | - Ignacio Madrazo
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
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Ikin Anderson M, Gopinath B, Fiona Jones K, Morey P, Simpson GK. Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study. Ann Phys Rehabil Med 2023; 66:101734. [PMID: 37030248 DOI: 10.1016/j.rehab.2023.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/06/2022] [Accepted: 12/10/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time. OBJECTIVE Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury. METHOD Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale). RESULTS In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI] = 0.971; Incremental Fit Index [IFI] = 0.986; Tucker-Lewis Index [TLI] = 0.971; Comparative Fit Index [CFI] = 0.985 and Root Mean Square Error of Approximation [RMSEA] = 0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2. CONCLUSIONS The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.
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Affiliation(s)
| | - Bamini Gopinath
- Macquarie University Hearing, Macquarie University, North Ryde, NSW, Australia
| | - Kate Fiona Jones
- Institute for Ethics and Society, The University of Notre Dame, Sydney, NSW Australia; Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Peter Morey
- School of Nursing and Health, Avondale University, Sydney, NSW, Australia
| | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney, NSW, Australia
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DiMarco AF, Geertman RT, Nemunaitis GA, Kowalski KE. Impact of the cough stimulation system on the care burden and life quality of caregivers of tetraplegics. J Spinal Cord Med 2023; 46:778-788. [PMID: 37017634 PMCID: PMC10446787 DOI: 10.1080/10790268.2022.2148845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To determine caregiver burden and quality of life of primary family caregivers of participants with cervical SCI before and after use of the cough stimulation system (CSS). DESIGN Prospective assessment at four timepoints via questionnaire responses. SETTING Out-patient hospital, United States. PARTICIPANTS 15 primary family caregivers of participants with cervical SCI completed questionnaires including a respiratory care burden index (n = 15) and a commonly employed caregiver burden inventory (n = 9), before and at the 6-month, 1-year and 2-year timepoints following use of the CSS. RESULTS SCI participants had significant clinical improvements in terms of restoration of an effective cough and ability to manage airway secretions with use of the CSS. Restoration of expiratory muscle function with use of the CSS also resulted in less caregivers (CG) stress, greater control of their participants' breathing problems, and improvement in quality of life. Results of the caregiver burden inventory demonstrated marked reductions in caregiver burden in development items, physical health and social relationship. Overall caregiver burden fell from 43.4 ± 13.8 pre-implant to 32.4 ± 7.9 (P = 0.06), 31.7 ± 10.5 (P = 0.05), and 26.5 ± 9.3 (P = 0.01) at the 6-month, 1-year and 2-year timepoints. CONCLUSION Use of the CSS by cervical SCI participants results in restoration of an effective cough with significant clinical benefits. While caregiver burden is very high in primary family caregivers, they derive marked improvement in caregiver burden and quality of life with implementation of this device.Trial registration: ClinicalTrials.gov identifier: NCT00116337.Trial registration: ClinicalTrials.gov identifier: NCT01659541.
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Affiliation(s)
- Anthony F. DiMarco
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Research, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert T. Geertman
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gregory A. Nemunaitis
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Krzysztof E. Kowalski
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Research, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Desai RH, L'Hotta A, Kennedy C, James AS, Stenson K, Curtin C, Ota D, Kenney D, Tam K, Novak C, Fox I. Caregiving for People With Spinal Cord Injury Undergoing Upper Extremity Reconstructive Surgery: A Prospective Exploration of Lived Experiences, Perioperative Care, and Change Across Time. Top Spinal Cord Inj Rehabil 2023; 29:58-70. [PMID: 38076291 PMCID: PMC10644855 DOI: 10.46292/sci22-00063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Nerve transfer (NT) and tendon transfer (TT) surgeries can enhance upper extremity (UE) function and independence in individuals with cervical spinal cord injury (SCI). Caregivers are needed to make this surgery possible, yet caregivers experience their own set of challenges. Objectives This comparative study explored the perioperative and nonoperative experiences of caregivers of individuals with cervical SCI, focusing on daily life activities, burden, and mental health. Methods Caregivers of individuals with cervical SCI were recruited and grouped by treatment plan for the person with SCI: (1) no surgery (NS), (2) TT surgery, and (3) NT surgery. Semistructured interviews were conducted at baseline/preoperative, early follow-up/postoperative, and late follow-up/postoperative. Caregivers were asked about their daily life, mental health, and challenges related to caregiving. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative, single-item standardized burden score (0-100) data were collected at each timepoint. Results Participants included 23 caregivers (18 family members, 4 friends, 1 hired professional). The surgeries often brought hope and motivation for caregivers. Caregivers reported increased burden immediately following surgery (less for the NT compared to TT subgroup) yet no long-term changes in the amount and type of care they provided. NS caregivers discussed social isolation, relationship dysfunction, and everyday challenges. Conclusion Health care providers should consider the changing needs of SCI caregivers during perioperative rehabilitation. As part of the shared surgical decision-making approach, providers should educate caregivers about the postoperative process and the extent and potential variability of short- and long-term care needs.
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Affiliation(s)
- Rachel Heeb Desai
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Allison L'Hotta
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Carie Kennedy
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Doug Ota
- Palo Alto Veterans’ Healthcare System, Palo Alto, California
| | - Deborah Kenney
- Department of Orthopedic Surgery, Stanford University, Palo Alto, California
| | - Katharine Tam
- Saint Louis Veterans’ Healthcare System, St. Louis, Missouri
| | - Christine Novak
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ida Fox
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Ruoss M, Brach M, Pacheco Barzallo D. Labor market costs for long-term family caregivers: the situation of caregivers of persons with spinal cord injury in Switzerland. BMC Health Serv Res 2023; 23:676. [PMID: 37349784 DOI: 10.1186/s12913-023-09565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Family members are key in the provision of care to persons facing disability. To undertake the role as caregivers, they face many costs, being the setback in the labor market one of the most relevant. METHODS We analyze comprehensive data from long-term family caregivers of persons with spinal cord injury (SCI) in Switzerland. Using information about their working situation before and after becoming caregivers, we estimated the reduction in working hours and the associated income loss. RESULTS On average, family caregivers reduced their working hours by about 23% (8.4 h per week), which has a monetary value of CHF 970 per month (EUR 845). Women, older caregivers, and less educated caregivers have a much higher opportunity cost in the labor market: CHF 995 (EUR 867), CHF 1,070 (EUR 932), and CHF 1,137 (EUR 990) respectively. In contrast, family members who care for a person that works have a much lower impact on their working status, CHF 651 (EUR 567). Interestingly, the reduction in their working time is only a third of the extra work they face as caregivers. CONCLUSION Health and social systems rely on the unpaid work of family caregivers. To guarantee their long-term involvement, family caregivers need to be recognized for their work and potentially compensated. Without family caregivers, it is very unlikely societies can cope with the increasing need for care, as professional services are limited and expensive.
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Affiliation(s)
- Monica Ruoss
- Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland
| | - Diana Pacheco Barzallo
- Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland.
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Lucerne, Switzerland.
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Brady J, Mouneimne M, Milaney K. Environmental and systems experiences of persons with spinal cord injury and their caregivers when transitioning from acute care to community living during the COVID-19 pandemic: a comparative case study. Spinal Cord Ser Cases 2023; 9:8. [PMID: 36906673 PMCID: PMC10006547 DOI: 10.1038/s41394-023-00561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/13/2023] Open
Abstract
STUDY DESIGN Comparative case study OBJECTIVES: To elevate the voices of and capture the lived environmental and systems experiences of persons with spinal cord injury (PWSCI) and their caregivers, in transitions from inpatient rehabilitation to the community. Also, to examine the perceived and actual availability and accessibility of services and programs for this group. SETTING Inpatient rehabilitation unit and community in Calgary, Alberta, Canada METHODS: As a comparative case study, this research included multiple sources of data including brief demographic surveys, pre- and post-discharge semi-structured interviews, and conceptual mapping of services and programs for PWSCI and caregivers in Calgary, Canada (dyads). Three dyads (six participants) were recruited from an inpatient rehabilitation unit at an acute care facility, from October 2020 to January 2021. Interviews were analyzed using the Interpretative Phenomenological Analysis approach. RESULTS Dyads described transition experiences from inpatient rehabilitation to community as uncertain and unsupported. Breakdowns in communication, COVID-19 restrictions, and challenges in navigating physical spaces and community services were identified by participants as concerns. Concept mapping of programs and services showed a gap in identification of available resources and a lack of services designed for both PWSCI and their caregivers together. CONCLUSIONS Areas for innovation were identified that may improve discharge planning and community reintegration for dyads. There is an intensified need for PWSCI and caregiver engagement in decision-making, discharge planning and patient-centered care during the pandemic. Novel methods used may provide a framework for future SCI research in comparable settings.
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Affiliation(s)
- Jocelyn Brady
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Katrina Milaney
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Defi IR, Hamam NR, Biben V, Al Barqi NC. Improving functional outcomes and quality of life in an elderly woman with sarcopenia and spinal Tuberculosis: A case report. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1076010. [PMID: 36817719 PMCID: PMC9935826 DOI: 10.3389/fresc.2023.1076010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023]
Abstract
Background Indonesia is the world's second-largest contributor to TB patients. According to prevalence by age, the elderly have the most diagnosed TB. In Indonesia, TB spondylitis affects approximately 5% of TB cases and is a common cause of non-traumatic spinal cord injury (NTSCI). Spinal cord injury (SCI) is a growing public health concern, particularly among the elderly, as many of its populations have sarcopenia. Due to the complete absence of voluntary muscle contraction, SCI is followed by a rapid loss of skeletal muscle mass. SCI has several physical, psychological, social, and economic consequences. Case presentation A 68-years-old woman presented with weakness and numbness of all four limbs. She also had sarcopenia, malnutrition, and dependency on activities of daily living (ADL). In addition, the patient was at a risk of SCI complications. Magnetic resonance imaging (MRI) showed destruction of the vertebral bodies at the level of the 5th and 6th cervical area, tuberculous abscesses of the paravertebral and longus colli muscles. The patient underwent debridement and spinal stabilization. However, the patient was at a risk of developing SCI complications. In these patients, the Physical Rehabilitation and Medicine (PRM) strategy focuses on improving medical conditions, including preventing secondary complications, promoting neurological recovery, and optimizing function. Conclusion This case highlights the importance of PRM intervention in assessing functional disorders in the elderly to improve their quality of life (QOL).
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Affiliation(s)
- Irma Ruslina Defi
- Physical Medicine and Rehabilitation Department, Hasan Sadikin General Hospital, Faculty of Medicine Padjadjaran University, Bandung, Indonesia,Correspondence: Irma Ruslina Defi
| | - Nur Rusyidah Hamam
- Physical Medicine and Rehabilitation Department, Hasan Sadikin General Hospital, Faculty of Medicine Padjadjaran University, Bandung, Indonesia
| | - Vitriana Biben
- Physical Medicine and Rehabilitation Department, Hasan Sadikin General Hospital, Faculty of Medicine Padjadjaran University, Bandung, Indonesia
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Osborne JB, Rocchi MA, McBride CB, McKay R, Gainforth HL, Upper R, Sweet SN. Couples' experiences with sexuality after spinal cord injury. Disabil Rehabil 2023; 45:664-672. [PMID: 35191794 DOI: 10.1080/09638288.2022.2040611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To explore sexuality after spinal cord injury (SCI) from the perspectives of individuals with SCI and their romantic partners. METHODS A sample of 8 Canadian adults with SCI (6 men, 2 women) and their partners participated in this study (N = 16). Semi-structured dyadic and individual interviews were conducted, discussions surrounding sexuality and intimacy were extracted, and a qualitative description of the interview data was performed using thematic analysis. RESULTS Three major themes were identified: the changing definition of sex; emotions; and practical support. Couples' conversations around the changing definition of sex after SCI addressed the taboo topic of sexuality and the importance of communication between couples, peers, and healthcare providers. Emotions included fears of losing intimacy, embarrassment in managing bladder and bowel interference, and acceptance in balancing being a romantic partner and a caregiver. Finally, couples reported challenges accessing practical support including medical interventions and sexual health nurses, but saw value in peer mentorship programs. CONCLUSION Couples explored a changing definition of sex following SCI that was complicated by the taboo nature of discussing sexuality, experienced a range of emotions throughout the recovery process, and had difficulties navigating the healthcare system for appropriate support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should promote discussion and provide support for sexuality following SCI, but during initial rehabilitation may be too early.Healthcare providers should prepare people with SCI and their partners for the inevitable trial-and-error process involved in sexual rehabilitation.Rehabilitation professionals could direct couples to SCI peer mentorship programs to help normalize the experiences and emotions of sexual rehabilitation.
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Affiliation(s)
- Jake B Osborne
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Meredith A Rocchi
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rhyann McKay
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Randy Upper
- Lawson Health Research Institute, London, Ontario, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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12
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Mohammed RS, Boateng EA, Amponsah AK, Kyei-Dompim J, Laari TT. Experiences of family caregivers of people with spinal cord injury at the neurosurgical units of the Komfo Anokye Teaching Hospital, Ghana. PLoS One 2023; 18:e0284436. [PMID: 37083720 PMCID: PMC10121035 DOI: 10.1371/journal.pone.0284436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) often leaves affected persons with a lifelong demand for care. As a result, the effect of the condition goes beyond the injured person to affect family members and significant others who have to adjust their lives to provide care and support. However, little is known about the experiences of these family caregivers regarding the care of people with SCI in Ghana. Exploring their experiences would enhance the understanding of family caregiving of people with SCI and contribute to policy intervention. METHODS This qualitative descriptive phenomenology study used the purposive sampling method to select 10 family caregivers. Data were collected using a semi-structured interview guide through individual in-depth interviews. Written informed consent was obtained and interviews were audio-recorded and transcribed verbatim. Data were manually analysed following Colaizzi's method of data analysis. RESULTS In all, 4 main themes emerged from the analysis of data (1) becoming a caregiver, (2) roles of the caregiver, (3) the burden of caregiving, and (4) coping strategies. The family caregivers provided vital assistance to their relatives with SCI and experienced physical and financial burdens as a result of the care. Due to the strains involved in the caregiving process, family caregivers adopted various strategies to cope with the situation. CONCLUSION This study has provided evidence of the lived experiences of family caregivers of people with SCI in the Ghanaian context and further supports the findings of previous studies. Measures including training, counselling, and instituting social support services for family caregivers should be considered by the management of healthcare institutions to enhance the experiences of family caregivers.
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Affiliation(s)
- Rumana Saeed Mohammed
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Edward Appiah Boateng
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Kusi Amponsah
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joana Kyei-Dompim
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Timothy Tienbia Laari
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Presbyterian Primary Health Care (PPHC), Bolgatanga, Ghana
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13
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LaVela SL, Pedersen J, Ehrlich-Jones L, Heinemann AW. Positive and negative ways that informal caregivers are affected by weight and weight management efforts for care recipients with spinal cord injury. Disabil Rehabil 2022; 44:7152-7160. [PMID: 34613825 DOI: 10.1080/09638288.2021.1985629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To understand how informal caregivers are affected by weight and weight management of care recipients with SCI. MATERIALS AND METHODS In-depth qualitative interviews were conducted with 24 informal caregivers of community-dwelling Veterans and civilians with SCI. Thematic analysis was conducted. RESULTS Three themes described how the care recipient's weight management efforts impacted the caregiver, including: (1) motivation and involvement in weight management efforts for themselves, (2) emotional well-being (positive and negative aspects), and (3) physical tasks (both ease and burden). Caregivers may experience emotional and/or physical burden by taking on extra caregiving tasks to help with care recipient's weight management. Caregivers also may experience positive impacts from the care recipient's weight management efforts, regardless of who drove the efforts, including improvement in their own motivation and involvement in weight management, enhanced emotional well-being (happiness for and with the care-recipient), and making physical caregiving tasks easier. CONCLUSIONS Rehabilitation providers can use these findings to educate dyads about potential impacts of weight management efforts for the care recipient, specifying areas that may cause burden but emphasizing the potential benefits for both recipient and caregiver. Integrating this education into rehabilitation practice may reduce overweight-related problems with function and declines in disability among dyads.Implications for RehabilitationInformal caregivers experience both positive and negative consequences with regard to weight management for individuals with SCI.Helping their loved one with weight management can facilitate informal caregivers' involvement in their own weight management activities.Findings may offer guidance to healthcare and rehabilitation providers as they incorporate weight management into education programs for informal caregivers of persons with SCI.Integrating this education into rehabilitation practice may reduce or delay overweight-related problems with function and declines in disability among dyads.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica Pedersen
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
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14
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Dekeseredy P, Hickman WP, Fang W, Sedney CL. Traumatic spinal cord injury in West Virginia: Impact on long-term outcomes by insurance status and discharge disposition. J Neurosci Rural Pract 2022; 13:652-657. [PMID: 36743754 PMCID: PMC9893939 DOI: 10.25259/jnrp-2022-3-53-r1-(2492)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Specialized rehabilitation is important for people with traumatic spinal cord injuries (SCIs) to optimize function, independence and mitigate complications, and access to this service varies by the payor. In West Virginia, admission to acute rehabilitation facilities is a "non-covered entity," impeding access to this care for patients with SCI and Medicaid. Our previous work examined the discharge disposition from an acute care hospital of patients with and without Medicaid and found that Medicaid patients were almost twice as likely to be discharged home or to a nursing home, despite similar injury severity and younger age compared to non-Medicaid patients. West Virginia is a largely rural state with multiple health-care challenges. A lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference. This present study examines the relationship between insurance coverage, discharge disposition at time of injury, and long-term outcomes for people in West Virginia with traumatic SCI. Materials and Methods This study utilized a retrospective chart review and telephone survey from a Level 1 Trauma Center in West Virginia. Participants included 200 patients with traumatic SCI from 2009 to 2016 in West Virginia. Thirty-four patients completed the survey through telephone interviews, with another 16 completing the survey but declining to answer economic questions. Survey participants were asked the Craig Handicap Assessment and Reporting Technique (CHART), which indicates the degree of impairment, and disability; they experience years after initial injury and rehabilitation. Proportional odds regression models, a regression model generalization of the Wilcoxon rank sum test, were employed where normal distribution of the response variables was not assumed and was performed, controlling for age and injury severity. Results Total CHART score correlated with discharge disposition (P = 0.01). Insurance type correlated with mobility sub-score (P = 0.03). Conclusion Patients discharged to a rehabilitation center have overall higher CHART scores post-injury, indicating better long-term outcomes than those discharged home or a nursing home. People with Medicaid as payors had lower scores for mobility than those with other insurance coverage.
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Affiliation(s)
| | | | - Wei Fang
- West Virginia Clinical and Translational Science Institute, Erma Byrd Biomedical Research Center, Morgantown, West Virginia
| | - Cara L. Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
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15
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LaVela SL, Pedersen J, Ehrlich-Jones L, Heinemann AW. Informal caregivers' self-identified roles in facilitating health-promoting behaviours for weight management in community-dwelling care recipients living with spinal cord injury in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1585-e1598. [PMID: 34595792 DOI: 10.1111/hsc.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health-promoting behaviours of healthy eating and physical activity among community-dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post-injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health-promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi-structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis. Participants included informal caregivers of individuals with SCI living in the community (n = 24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and (8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health-promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self-identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health-promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jessica Pedersen
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
| | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
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16
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Lee SJ, Kim MG, Kim JH, Min YS, Kim CH, Kim KT, Hwang JM. Factor Analysis Affecting Degree of Depression in Family Caregivers of Patients with Spinal Cord Injury: A Cross-Sectional Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10878. [PMID: 36078592 PMCID: PMC9517793 DOI: 10.3390/ijerph191710878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
This study was conducted to determine the degree of depression in family caregivers of spinal-cord-injury patients and to identify factors influencing family caregivers' depression. The final study subjects were 30 (family caregivers: 6 males and 24 females). The CES-D of family caregivers; general characteristics of spinal-cord-injury patients and family caregivers; and information on physical health, household income, leisure, social activity, family relationship, and life-in-general status of family caregiver were collected. A frequency analysis, normality test, Mann-Whitney test, Kruskal-Wallis test, Spearman Correlation analysis, hierarchical regression analysis, and spider network through a path model analysis were performed. As for the general characteristics, when the patient was economically active, the caregiver's depression was mean ± SD; 2.04 ± 0.71; otherwise, it was mean ± SD 2.86 ± 0.74, indicating that the caregiver of the non-economic activity patient was more depressed (p = 0.013). In Model 1 of the multiple regression analysis to understand the effect on the depression of the caregiver, it was confirmed that the depression of the caregiver decreased as the family caregiver had more leisure and social activities (B = -0.718, p = 0.001). In Model 2, it was found that the depression of caregivers increased when the patient did not engage in economic activity (B = 0.438, p = 0.016). In the spider-web form through the path model analysis, as the family's economic level increased, physical health increased by B = 0.755 (p < 0.001), and the increase in physical health (B = 0.424, p = 0.042) was, in turn, a factor in the increase of engagement in leisure and social activities. Various policies will be needed for the successful return to society of spinal-cord-injury patients by ensuring that their leisure and social activities and establishing measures to support their economical income.
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Affiliation(s)
- Su-Jin Lee
- Graduate School of Public Health, Kyungpook National University, Daegu 41944, Korea
| | - Myung-Gwan Kim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam 13415, Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam 13415, Korea
| | - Jung hee Kim
- College of Pharmacy, Industrial Pharmacy, Chungbuk National University, Cheongju-si 28644, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu 41944, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea
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17
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Budd MA, Gater DR, Channell I. Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071178. [PMID: 35887675 PMCID: PMC9320050 DOI: 10.3390/jpm12071178] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.
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Affiliation(s)
- Maggi A. Budd
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isabella Channell
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Mental Health Counseling and Behavioral Medicine Graduate Program, Boston University School of Medicine, Boston, MA 02128, USA
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18
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Caregivers' Knowledge, Attitude, and Practice towards Pressure Injuries in Spinal Cord Injury at Rehabilitation Center in Bangladesh. Adv Orthop 2022; 2022:8642900. [PMID: 35747167 PMCID: PMC9213162 DOI: 10.1155/2022/8642900] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/26/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to determine caregivers' knowledge, attitude, and practice (KAP) on the prevention and care of pressure injuries (PIs) in individuals with spinal cord injury. A quantitative cross-sectional study with descriptive correlation design was used to implement a modified semistructured questionnaire using a convenient sampling method. McDonald's standard of learning outcome measurement criteria was used to categorize caregivers' KAP. A Pearson product-moment correlation coefficient (r) was utilized to assess the relationships between caregivers' KAP, with a p value of 0.05 or less considered statistically significant. The study findings indicate that caregivers had a moderate level of knowledge (M = 73.68%, SD = 6.43), a neutral attitude (M = 70.32%, SD = 6.89), and a moderate level of practice (M = 74.77%, SD = 9.08). A positive correlation existed between caregivers' knowledge and attitude (r = 0.30, p < 0.01), as well as between knowledge and practice (r = 0.37, p < 0.01). Nevertheless, there was no correlation between attitude and practice (r = 0.12, p > 0.05). The study findings suggest that caregivers need to develop a positive attitude and expand their knowledge in order to improve their practice. The KAP factors that require higher priority were positioning and turning the patient, preventing skin breakdown, assessing weight changes over time, interest in patient care, additional care for PIs, frequently changing the individual's position, priority to PI care, interest in other types of care other than PIs, using special cushions, consulting doctors on a regular basis, being aware of clothing and fabrics, proper transfer technique, pressure relief, and skin inspection, among others.
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19
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Self-Efficacy and Psychological Well-Being of Family Caregivers of Persons with Spinal Cord Injury. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00659-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Five Different Lives after Suffering from Spinal Cord Injury: The Experiences of Nurses Who Take Care of Spinal Cord Injury Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031058. [PMID: 35162081 PMCID: PMC8834452 DOI: 10.3390/ijerph19031058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/05/2023]
Abstract
According to statistics of Ministry of Health and Welfare, accidents were the sixth common causes of death in Taiwan in 2016. A total of 1200 new cases of spinal cord injury each year are caused by accidents and adverse effects. This study explored nurses' experience of caring for patients with spinal cord injury. Hermeneutic phenomenology was used in the data analysis. The five themes emerged: dramatic changes in life, life lost control, life after catastrophic injury, life takes turns for the worse for family, and the power of rebirth. This study revealed that accidents were the primary cause of spinal cord injury, and that nurses may neglect patients' mental and social care. Career guidance should be offered to spinal cord injury patients to ensure that they retain sociality. This study provides recommendations regarding a patient's and their family's post-injury adaption process. The sexual desire of patients should be further explored in future research.
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21
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Ryerson Espino SL, O’Rourke K, Kelly EH, January AM, Vogel LC. Coping, Social Support, and Caregiver Well-Being With Families Living With SCI: A Mixed Methods Study. Top Spinal Cord Inj Rehabil 2022; 28:78-98. [PMID: 35145337 PMCID: PMC8791416 DOI: 10.46292/sci21-00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To explore coping, problem solving, social support, and well-being among family caregivers of adults with spinal cord injury (SCI). METHODS This was a mixed methods study (qualitative interviews and standardized surveys) with a diverse sample of 39 adults with SCI and their caregivers from four rehabilitation hospitals in the United States, including one Veterans Affairs (VA) hospital. Cluster analysis was used to explore whether distinct profiles of caregivers could be identified, and it was used in conjunction with qualitative data to explore patterns in well-being. Measures of well-being included leisure time satisfaction, social integration, anxiety, depression, physical health complaints, caregiver burden, and quality of life. RESULTS The importance of individual and extra-individual resources, namely coping and social support, emerged from early qualitative analyses and guided subsequent mixed methods examination of the data. A cluster analysis yielded three caregiver profiles: (1) effective problem solvers with moderate satisfaction with social support, (2) mixed problem solvers with stronger negative orientations and mixed satisfaction with social support, and (3) low endorsers overall. Profiles helped us explore patterns across our data set and efficiently identify differences in caregiver social support, coping, well-being, and unmet needs. CONCLUSION Data echo the need for multimodal interventions aimed at skill development, respite options, and screening, support, information, and referral around mental health and burden. SCI care and rehabilitation programs should consider incorporating strategies for bolstering effective caregiver problem-solving skills, reducing negativity and ambivalence, and enhancing social support.
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Affiliation(s)
| | - Kerry O’Rourke
- Marquette University, Milwaukee, Wisconsin
,Shriners Children’s Chicago, Chicago, Illinois
| | | | - Alicia M. January
- Marquette University, Milwaukee, Wisconsin
,Purdue University Northwest, Hammond, Indiana
| | - Lawrence C. Vogel
- Marquette University, Milwaukee, Wisconsin
,Shriners Children’s Chicago, Chicago, Illinois
,Rush University, Chicago, Illinois
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22
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Dietz N, Sarpong K, Ugiliweneza B, Wang D, Aslan SS, Castillo C, Boakye M, Herrity AN. Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:53-67. [PMID: 34866888 DOI: 10.46292/sci21-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988-2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Kwadwo Sarpong
- School of Medicine, Georgetown University, Washington, DC
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,Department of Health Management and Systems Science, University of Louisville, Louisville, Kentucky
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Sevda S Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Camilo Castillo
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, Kentucky
| | - Maxwell Boakye
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - April N Herrity
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,Department of Physiology, University of Louisville, Louisville, Kentucky
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23
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Huang J, Pacheco Barzallo D, Rubinelli S, Münzel N, Brach M, Gemperli A. Professional home care and the objective care burden for family caregivers of persons with spinal cord injury: Cross sectional survey. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2020.100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Simpson GK, Anderson MI, Daher M, Jones KF, Morey P. Testing a Model of Resilience in Family Members of Relatives with Traumatic Brain Injury vs Spinal Cord Injury: Multigroup Analysis. Arch Phys Med Rehabil 2021; 102:2325-2334. [PMID: 34358498 DOI: 10.1016/j.apmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To test a model comprising explanatory (neurologic impairment, coping, personality) and mediating (resilience, self-efficacy, hope, social support) variables on psychological adjustment and burden among family caregivers of individuals with traumatic brain injury (TBI) vs spinal cord injury (SCI). DESIGN Structural equation modeling with multigroup analysis. SETTING Six rehabilitation centers across New South Wales and Queensland, Australia. PARTICIPANTS A total of 181 family members (N=181; 131 TBI, 50 SCI). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Connor-Davidson Resilience Scale, Eysenck Personality Questionnaire, Ways of Coping Questionnaire, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey; and 4 measures of psychological adjustment including: Caregiver Burden Scale, Medical Outcomes Survey Short Form-36 (SF-36), General Health Questionnaire-28, and Positive and Negative Affect Scale. RESULTS The model for the aggregated sample demonstrated a very good model fit (χ2=47.42, df=39, ρ=0.167, normed fit index=.962, incremental fit index=.993, Tucker-Lewis index=.985, comparative fit index=.993, root-mean-squared error of approximation=.035). Multi-group analysis found significant commonalities in the pattern of relationships among variables across the 2 groups. In the only differences found, neuroticism was significantly more influential on burden in family members supporting individuals with TBI than family members of individuals with SCI. Furthermore, problem-focused coping was statistically more influential on positive affect in family members of individuals with TBI when compared with family members of individuals with SCI. CONCLUSIONS The study found significant similarities in the patterns of resilience and psychological adjustment among family caregivers of individuals with TBI and SCI.
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Affiliation(s)
- Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney; Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney.
| | | | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney; Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney
| | - Kate F Jones
- Institute for Ethics and Society, The University of Notre Dame, Sydney, Australia
| | - Peter Morey
- School of Nursing and Health, Avondale University, Sydney
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Intas G, Petta M, Platis C, Chalari E, Stergiannis P. The Burden on Carers with Multiple Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:169-175. [DOI: 10.1007/978-3-030-78771-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pullin LH, McKenzie H. Lifetime Active Care: A qualitative study of long-term family carers of people with spinal cord injury in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1622-1631. [PMID: 32239619 DOI: 10.1111/hsc.12987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
This study reports the findings of a qualitative, grounded theory study which explored the experiences of partners and other long-term family carers living with and supporting loved ones with spinal cord injury. The study is exploratory in that little was previously known about the experience of long-term care-giving in this context in Australia. Most research in this area has focused on this experience during the first 5 years postinjury. This study focuses on the experiences of family carers beyond that 5-year period. The study aimed to explore the experience of partners and other long-term family carers of people with spinal cord injury, and illuminate their daily lives, interests, concerns and caring approaches in this context. Data collection included in-depth interviews, a focus group and an on-line, password-protected research blog for participant narrative reflections. Findings revealed that the experience of long-term caring is complex, all-encompassing and lifelong. This experience is conceptualised here as lifetime active care which always involves what we describe as protective, negotiated, surreptitious and strategic caring. These dimensions of caring are interdependent and deeply embedded in the daily, active support provided by long-term carers of people with spinal cord injury. We argue that carers in this context are involved in processes that have, in other contexts, been conceptualised as narrative reconstruction and also that the four dimensions of caring identified involve significant emotion work. The social processes of lifetime active care may shed light on the experiences of family carers in other long-term care contexts.
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Affiliation(s)
- Laynie Hall Pullin
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Is caregiver quality of life predicted by their perceived burden? A cross-sectional study of family caregivers of people with spinal cord injuries. Spinal Cord 2020; 59:185-192. [PMID: 32753723 DOI: 10.1038/s41393-020-0528-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To identify predictors of quality of life (QoL) among family caregivers of people with spinal cord injuries (SCI), considering caregiver and care recipient characteristics, and to evaluate the predictive value of caregiver burden (CB) on the QoL of family caregivers. SETTING Multicenter study in four spinal units across Italy. METHODS Secondary analysis of the data obtained during the validation of the Italian version of the Caregiver Burden Inventory in Spinal Cord Injuries (CBI-SCI) questionnaire. In all, 176 family caregivers completed a socio-demographic questionnaire, the Short Form-36, the CBI-SCI, and the Modified Barthel Index. A first linear regression analysis was performed to identify independent predictors of each domain of caregiver QoL. A second linear regression analysis including CBI-SCI was then performed to evaluate the predictive value of CB on caregiver QoL. RESULTS Participants reported reduced physical and mental QoL. Significant predictors of lower scores in physical dimensions of QoL were older age and female gender. Contextual factors following SCI, such as economic difficulties and the presence of a formal caregiver, significantly predicted emotional QoL in family caregivers. Identified predictors explained 13-32% of variance. CB was a significant predictor (p < 0.001) when added to all proposed models, increasing the explained variance from 7 to 26%. CONCLUSION Neither the clinical characteristics of, nor the relationship with care recipients predicted a worse caregiver QoL, whereas the CB did. The CB was a strong predictor of QoL among family caregivers and should be kept to a minimum to promote caregiver well-being.
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Geard A, Kirkevold M, Løvstad M, Schanke AK. How do family members of individuals with spinal cord and acquired brain injuries make sense of their experiences: A qualitative study of meaning making processes. Health Psychol Open 2020; 7:2055102920913477. [PMID: 32284872 PMCID: PMC7133077 DOI: 10.1177/2055102920913477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This study explores the processes that promote coping with abruptive life
changes, often experienced as life before and after injury. The consept of
meaning making, was used as theoretical framework for analysisthr. Family
members of individuals with spinal cord and acquired brain injury participated
in two focus groups three to twenty years post-injury. Data was analysed using
thematic analyses. Two main themes were identified: drawing upon different
coping strategies and balancing family needs against personal autonomy. Making
sense of an altered situation was by keeping a positive outlook, making
comparisons to worst cases, engagement in activities and making room for own
needs. Thus, the study illistrates that life can continue in a good manner after
adversities, but requires flexibility and adjustments.
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Affiliation(s)
- Anne Geard
- University of Oslo, Norway.,Sunnaas Rehabilitation Hospital, Norway
| | | | - Marianne Løvstad
- University of Oslo, Norway.,Sunnaas Rehabilitation Hospital, Norway
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Conti A, Clari M, Nolan M, Wallace E, Tommasini M, Mozzone S, Campagna S. The Relationship Between Psychological and Physical Secondary Conditions and Family Caregiver Burden in Spinal Cord Injury: A Correlational Study. Top Spinal Cord Inj Rehabil 2020; 25:271-280. [PMID: 31844379 DOI: 10.1310/sci2504-271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Caregiver burden (CB) is a consequence of providing care to people with spinal cord injury (SCI). However, there is a lack of clarity about the influence of secondary conditions of care recipients on family caregivers. Secondary conditions refer to the physical and psychological complications that can occur after SCI and lead to increased hospitalization and reduced functionality, quality of life, and social participation. Objective: To assess the impact of physical and psychological secondary conditions of people with SCI on the perceived burden of family caregivers. Methods: A multicenter, cross-sectional study of 56 dyads of family caregivers and individuals with SCI in two urban spinal units in Italy and Ireland. Care recipients completed a toolset consisting of demographic information and assessments of functional, physical, and psychological health. Caregivers completed a multidimensional measure of CB. Bivariate data analysis was used. Results: No significant differences between centers were identified. CB was found to be related to physical secondary conditions and functional independence but not to mental health of care recipients. Bladder dysfunction and urinary tract infections influenced all dimensions of CB, whereas pressure injuries influenced only the time-dependent dimension. Level and completeness of injury and duration of caregiving increased CB. Conclusion: Findings indicate the value of a reduction in secondary conditions not just for individuals with SCI but also for their family caregivers. To reduce the individual and family burden of secondary conditions, a two-pronged, multidimensional approach, focusing on self-management for care recipients and psychoeducational support for caregivers, is required.
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Affiliation(s)
- Alessio Conti
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Universita degli Studi di Torino, Torino, Italy
| | - Marco Clari
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Universita degli Studi di Torino, Torino, Italy
| | - Maeve Nolan
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Eva Wallace
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Marco Tommasini
- Spinal Unit, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Silvia Mozzone
- Spinal Unit, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Sara Campagna
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Universita degli Studi di Torino, Torino, Italy
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Guidance for behavioural interventions aiming to support family support providers of people with spinal cord injury: A scoping review. Soc Sci Med 2020; 246:112456. [DOI: 10.1016/j.socscimed.2019.112456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 06/17/2019] [Accepted: 07/28/2019] [Indexed: 01/07/2023]
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Jeyathevan G, Cameron JI, Craven BC, Jaglal SB. Identifying Required Skills to Enhance Family Caregiver Competency in Caring for Individuals With Spinal Cord Injury Living in the Community. Top Spinal Cord Inj Rehabil 2019; 25:290-302. [PMID: 31844381 DOI: 10.1310/sci2504-290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Due to the earlier discharge of individuals with spinal cord injury (SCI), family caregivers are often left with limited time for learning caregiving skills, and they usually feel unprepared to undertake the caregiver role. Objective: Considering the key role of family caregivers in maintaining the overall health and well-being of the individual with SCI, the objective of this study was to determine the breadth of skills needed by family caregivers to enhance their competency in caring for individuals with SCI living in the community. Methods: A qualitative descriptive approach was used with semi-structured interviews. Thematic analysis was used to determine key themes arising from the experiences of individuals with SCI (n= 19) and their family members (n = 15). Results: Twenty-nine SCI family caregiving skills were identified and grouped into six caregiving processes signifying the multiple dimensions of the SCI caregiving role. These include monitoring and managing physical health and secondary health conditions, providing for psychosocial needs, decision making, time management, being flexible, and navigating the health and social services system. Conclusion: The current study demonstrated that development of multiple caregiving skills is crucial to enhance family members' competency in caregiving. These findings should further alert health care professionals that assessment of caregiving skills at regular intervals is necessary to help caregivers achieve mastery in situations where they are facing caregiving difficulties. Future programs need to be designed to include the skills that family caregivers need and use in real-life caregiving situations.
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Affiliation(s)
- Gaya Jeyathevan
- Institute of Health Policy, Management and Evaluation, University of Toronto.,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Jill I Cameron
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto.,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto.,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Fox I, Hoben G, Komaie G, Novak C, Hamm R, Kahn L, Whitehead M, Juknis N, Ruvinskaya R, Mackinnon S, James A. Nerve transfer surgery in cervical spinal cord injury: a qualitative study exploring surgical and caregiver participant experiences. Disabil Rehabil 2019; 43:1542-1549. [PMID: 31560228 DOI: 10.1080/09638288.2019.1669225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate perceptions of surgical participants and their caregivers regarding novel nerve transfer surgery to restore upper extremity function in cervical level spinal cord injury. MATERIALS AND METHODS A qualitative study design was used. A multidisciplinary team developed semi-structured interview guides. Interviews were recorded, transcribed and analyzed using basic text analysis. RESULTS Participants had limited information about procedures to improve function after spinal cord injury. When discussing their choice to undergo nerve (as compared to traditional tendon) transfer surgery, they describe a desire to avoid post-operative immobilization. Barriers included the pre-operative testing, cost and inconvenience of travel for surgery, and understanding complex health information related to the procedure. While expectations matched descriptions of outcomes among participants and were generally positive, caregivers expressed disappointment. The long time interval for gains in function to be realized and relatively incremental gains achieved were frustrating to all. CONCLUSIONS People with cervical spinal cord injury and their caregivers need more information about options to restore function and about realistic range of improvements with treatment. Further work to mitigate barriers and develop health information materials around nerve transfer surgery may improve medical decision making around and appropriate use of this newer treatment option.IMPLICATIONS FOR REHABILITATIONNerve transfer surgery is a novel and acceptable means of improving upper extremity function in the setting of cervical spinal cord injury.People with cervical spinal cord injury and their caregivers need information about options to restore hand and arm function and mitigation of barriers around these treatment options.
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Affiliation(s)
- Ida Fox
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, United States.,Division of Plastic Surgery, Veterans Administration Saint Louis Health Care System, Saint Louis, United States
| | - Gwendolyn Hoben
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, United States
| | - Goldie Komaie
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, United States
| | - Christine Novak
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Rebecca Hamm
- School of Physical Therapy, Washington University School of Medicine, Saint Louis, United States
| | - Lorna Kahn
- Milliken Hand Rehabilitation Center, Department of Occupational Therapy, Washington University School of Medicine, Saint Louis, United States
| | - Meredith Whitehead
- School of Physical Therapy, Washington University School of Medicine, Saint Louis, United States
| | - Neringa Juknis
- Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, Saint Louis, United States
| | - Rimma Ruvinskaya
- Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, Saint Louis, United States
| | - Susan Mackinnon
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, United States
| | - Aimee James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, United States
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Jeyathevan G, Cameron JI, Craven BC, Munce SEP, Jaglal SB. Re-building relationships after a spinal cord injury: experiences of family caregivers and care recipients. BMC Neurol 2019; 19:117. [PMID: 31176359 PMCID: PMC6555989 DOI: 10.1186/s12883-019-1347-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/31/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Following spinal cord injury (SCI), family members are often called upon to undertake the caregiving role. This change in the nature of the relationship between the individuals with SCI and their families can lead to emotional, psychological, and relationship challenges. There is limited research on how individuals with SCI and their family caregivers adapt to their new lives post-injury, or on which dyadic coping strategies are used to maintain relationships. Thus, the objectives of this study were to obtain an in-depth understanding of 1) the experiences and challenges within a caregiving relationship post-SCI among spouses, as well as parents and adult children; and 2) the coping strategies used by caregivers and care recipients to maintain/rebuild their relationships. METHODS A qualitative descriptive approach with an exploratory design was used. Semi-structured face-to-face and telephone interviews were conducted. Thematic analysis was used to identify key themes arising from individuals with SCI's (n = 19) and their family caregivers' (n = 15) experiences. RESULTS Individuals with SCI and family caregivers spoke in-depth and openly about their experiences and challenges post-injury, with two emerging themes (including subsequent sub-themes). The first theme of deterioration of relationship, which reflects the challenges experienced/factors that contributed to disintegration in a relationship post-injury, included: protective behaviours, asymmetrical dependency, loss of sex and intimacy, and difficulty adapting. The second theme of re-building/maintaining the relationship, which reflects the strategies used by dyads to adjust to the changes within the relationship brought upon by the injury, included: interdependence, shifting commonalities, adding creativity into routine, and creating a new normal. CONCLUSIONS These findings should alert healthcare professionals and peer support groups as to the need for possible education and training (e.g., coping strategies, communication skills training) as well as counseling prior to discharge to assist individuals with SCI and family caregivers with adaptation to a new life post-injury.
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Affiliation(s)
- Gaya Jeyathevan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Neural Engineering and Therapeutics Team, KITE, Toronto Rehab - University Health Network, Toronto, Ontario, Canada
| | - Jill I Cameron
- Neural Engineering and Therapeutics Team, KITE, Toronto Rehab - University Health Network, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Toronto, Ontario, Canada
| | - B Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Neural Engineering and Therapeutics Team, KITE, Toronto Rehab - University Health Network, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E P Munce
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Neural Engineering and Therapeutics Team, KITE, Toronto Rehab - University Health Network, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Neural Engineering and Therapeutics Team, KITE, Toronto Rehab - University Health Network, Toronto, Ontario, Canada. .,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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Jones KF, Simpson G, Briggs L, Dorsett P, Anderson M. A study of whether individual and dyadic relations between spirituality and resilience contribute to psychological adjustment among individuals with spinal cord injuries and their family members. Clin Rehabil 2019; 33:1503-1514. [DOI: 10.1177/0269215519845034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: To test a model of spiritual well-being and resilience among individuals with spinal cord injuries and their family members. Design: Prospective cross-sectional observational data were analyzed by structural equation modelling. Setting: Inpatient and community services at one rehabilitation hospital. Subjects: Individual with spinal cord injury ( n = 50) and family member ( n = 50) dyads. Interventions: Standard rehabilitation, both inpatient and community. Main measure(s): Functional assessment of chronic illness therapy – spiritual well-being scale – expanded, Connor–Davidson resilience scale, positive and negative affect scale, depression anxiety and stress scale–21, satisfaction with life scale. Results: Median time post-injury was 8.95 months (IQR (interquartile range) = 14.15). Individuals with spinal cord injury and family members reported high scores for both spiritual well-being (66.06 ± 14.89; 68.42 ± 13.75) and resilience (76.68 ± 13.88; 76.64 ± 11.75), respectively. Analysis found the model had acceptable fit (e.g. chi-square goodness of fit statistic = 38.789; P = .263). For individuals with spinal cord injury, spiritual well-being was positively associated with resilience which, in turn, was associated with increasing positive affect and satisfaction with life. Among family members, spiritual well-being was positively associated with resilience. Resilience was then associated with lowered levels of depression and mediated the impact of depression on satisfaction with life. Limited evidence was found for mutual dyadic links, with the only significant pathway finding that resilience in the individual with spinal cord injury was associated with increased satisfaction with life among family members. Conclusion: Increased spirituality and resilience make a significant contribution (both independently and in combination) to positive psychological outcomes for both individuals with spinal cord injury and their family members.
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Affiliation(s)
- Kate Fiona Jones
- Royal Rehab, Ryde, NSW, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Human Services and Social Work, Griffith University, Nathan, QLD, Australia
| | - Lynne Briggs
- School of Human Services and Social Work, Griffith University, Nathan, QLD, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Pat Dorsett
- School of Human Services and Social Work, Griffith University, Nathan, QLD, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
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Li K, Xie S, Wang Y, Tang J, He X, Liu T, Yan T. Outcome indicators in the transitional care of people with spinal cord injury in China: a Delphi survey based on the International Classification of Functioning, Disability and Health. Disabil Rehabil 2019; 42:1539-1547. [PMID: 30724613 DOI: 10.1080/09638288.2018.1528638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To identify the categories of the International Classification of Functioning, Disability and Health most suitable as outcome indicators in the transitional care for people with spinal cord injury in China.Methods: A three-round Delphi survey was conducted surveying 37 experts selected through purposive sampling. In the first round, each expert was required to suggest the most useful indicators in the transitional care for spinal cord injury patients. Categories of the International Classification of Functioning, Disability and Health were linked with the concepts extracted from the responses. In the second round, the experts were asked to make a yes/no judgment about the utility of those categories as outcome indicators and to rate their importance from 1 to 10. In the third round, the experts were asked to re-judge and re-rate the importance considering the second-round results.Results: Forty-one categories, seven personal factors, and three concepts not covered in the International Classification of Functioning, Disability and Health were identified. They generated agreement percentages over 80% in the third round. The means of the importance ratings ranged from 5.15 to 9.52.Conclusions: A set of categories and concepts was identified in the Delphi survey based on the International Classification of Functioning, Disability and Health. They provided a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.Implications for rehabilitationIn China, the people with spinal cord injury who live at home after discharge urgently need professional transitional care which can be extended from medical institutions to families.The categories and concepts identified by the Delphi survey based on the International Classification of Functioning, Disability and Health reflect the focuses in the transitional care of people with spinal cord injury in China.Those categories and concepts provide a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.
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Affiliation(s)
- Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Sumei Xie
- Department of Spinal Cord Injury Rehabilitation, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Yingmin Wang
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Tang
- Department of Spinal Cord Injury Rehabilitation, Sichuan Provincial Rehabilitation Hospital, Chengdu, China
| | - Xiaokuo He
- Department of Rehabilitation Medicine, Taihe Hospital, Shiyan, China
| | - Ting Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong Engineering Technology Research Center for Rehabilitation and Elderly Care, Guangzhou China
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Jeyathevan G, Catharine Craven B, Cameron JI, Jaglal SB. Facilitators and barriers to supporting individuals with spinal cord injury in the community: experiences of family caregivers and care recipients. Disabil Rehabil 2019; 42:1844-1854. [PMID: 30669882 DOI: 10.1080/09638288.2018.1541102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Family members make an important contribution to informal and formal care, as well as the overall health and wellbeing of individuals with spinal cord injury. Caregiving often results in negative outcomes which, if not addressed, threaten the sustainability of these critical supports. We sought to explore the perceptions of individuals with spinal cord injury and their family caregivers regarding the facilitators and barriers to undertaking and sustaining the caregiving role in the community.Methods: A qualitative descriptive approach with semi-structured interviews. Thematic analysis was employed to determine key themes arising from individuals with spinal cord injury (n = 19) and their family members' (n = 16) experiences.Results: The following four facilitators to caregiving were identified: access to community support services, positive coping in relationship, social support, and mastery of caregiving roles. Conversely, the following six barriers to caregiving were identified: lack of access to community resources, lack of knowledge about resources and formal training, fragmented continuity of care, negative coping in relationship, role strain, and caregiver injury or illness.Conclusions: The current study demonstrated that positive coping, social support, skills training, access to community services and continuity of care contribute significantly to the sustainability of the spinal cord injury family caregiving role. As such, the development of future caregiver interventions should consider these facilitators.Implications for RehabilitationFamily caregivers make an important contribution to the care processes and overall quality of life of individuals with spinal cord injury post-discharge into the community.The potential negative effects of caregiving could threaten the sustainability of these critical supports.Positive coping, social support, skills training, access to community services, and continuity of care contribute significantly to the sustainability of the spinal cord injury family caregiving role.This study shows the need for better integration of family members during the rehabilitation and discharge process to better prepare them for the caregiving role.
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Affiliation(s)
- Gaya Jeyathevan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network Toronto, Canada.,Department of Medicine Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Jill I Cameron
- Toronto Rehabilitation Institute, University Health Network Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Bourke JA, Nunnerley JL, Sullivan M, Derrett S. Relationships and the transition from spinal units to community for people with a first spinal cord injury: A New Zealand qualitative study. Disabil Health J 2018; 12:257-262. [PMID: 30262164 DOI: 10.1016/j.dhjo.2018.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/29/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Spinal Cord Injury (SCI) can have substantial consequences for the injured person, and also their family/whānau (Māori word for extended family and social networks). Family members can adopt either formal or informal care roles when the person returns home, and people with high-level care requirements may also need non-family support workers. OBJECTIVE This study considers how SCI can impact relationships during the transition from spinal rehabilitation units to home. METHOD Nineteen SCI participants from the New Zealand longitudinal study were interviewed six months post-discharge from either of New Zealand's two spinal units. Data were analysed using the framework method. RESULTS Three themes captured participants' relationship experiences during the time of transition: Role Disruption, examines how participants' pre-SCI family/whānau relationships underwent change as previously understood parameters of engagement were disrupted. A Balancing Act, explores the challenge of renegotiating previously-understood parameters between participants and whānau. The Stranger in My/Our Room focuses on how the relationship between participants and support workers was (necessarily) new to the participant and their family/whānau who now had an 'outsider' episodically or continuously in their home. The specifics of 'their' relationship was also new to the support worker; and negotiating the parameters of this relationship could only occur on transition home. CONCLUSION SCI necessitates a renegotiation of relationships and, for some, also involves the negotiation of a new type of relationship with support workers. Understanding the ways a SCI may affect relationships can enable rehabilitation services to best support people with SCI and their family to prepare for their transition home.
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Affiliation(s)
- John A Bourke
- Burwood Academy of Independent Living, Private Bag 4708, Christchurch 8140, New Zealand.
| | - Joanne L Nunnerley
- Burwood Academy of Independent Living, Private Bag 4708, Christchurch 8140, New Zealand; Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8140, New Zealand.
| | - Martin Sullivan
- Burwood Academy of Independent Living, Private Bag 4708, Christchurch 8140, New Zealand; School of Social Work, Massey University, Palmerston North 4442, New Zealand.
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin 9054, New Zealand.
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Hearn JH, Cotter I, Finlay KA. Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial. Arch Phys Med Rehabil 2018; 100:17-25. [PMID: 30268806 DOI: 10.1016/j.apmr.2018.08.182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI). DESIGN Randomized controlled feasibility study with 3-month follow-up. SETTING Community setting. PARTICIPANTS Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27). INTERVENTIONS An established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks. MAIN OUTCOME MEASURE Depression severity. RESULTS Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= -.891; 95% confidence interval,-1.48 to -.30) and T3 (mean difference=-1.96; 95% confidence interval, -2.94 to -.97). Mindfulness training also reduced anxiety at T2 (mean difference=-.888; 95% confidence interval, -1.40 to -.38) and T3 (mean difference=-2.44; 95% confidence interval, -3.20 to -1.69). CONCLUSIONS Results indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit.
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Affiliation(s)
| | - Imogen Cotter
- Department of Clinical Psychology, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, United Kingdom
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Relatives of people with spinal cord injury: a qualitative study of caregivers' metamorphosis. Spinal Cord 2018; 56:548-559. [PMID: 29563575 DOI: 10.1038/s41393-018-0092-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/05/2018] [Accepted: 02/01/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Qualitative study. OBJECTIVE To detect the major challenges and needs reported by family member caregivers of people with spinal cord injury (SCI). SETTING Family member caregivers of people with SCI and expert professionals were evaluated. This study was conducted in Spain, and most of the participants attended the National Paraplegics Hospital of Toledo. METHODS We performed 25 semi-structured interviews. The data were analyzed from a phenomenological perspective using the Colaizzi method. RESULTS The metamorphosis of the caregiver is a complex personal and family-related process. Analysis of the adjustment phase of the caregiving role allowed us to describe three stages, patterns, and trends. Five basic needs were identified. CONCLUSIONS People with SCI and their primary caregivers experienced changes in every sphere of their lives. Their most important needs were psychological support, social support, economic resources, information, training throughout the process of suffering, and the creation of informal groups of mutual aid.
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Characteristics and Health Outcomes of Post-9/11 Caregivers of US Service Members and Veterans Following Traumatic Brain Injury. J Head Trauma Rehabil 2018. [PMID: 29517593 DOI: 10.1097/htr.0000000000000384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To (a) characterize a sample of post-9/11 caregivers providing help to service members and veterans (SMV) following traumatic brain injury (TBI), (b) examine the level of support provided, and (c) determine caregiver health and well-being outcomes. SETTING Military treatment facility. PARTICIPANTS Caregivers (N = 278) of SMVs who sustained a mild, moderate, severe, or penetrating TBI (96.0% female; 86.0% spouse/partner; age: M = 38.7 years, SD = 10.4). Participants were divided into 3 groups on the basis of the level of support provided (low, medium, high). DESIGN Prospective observational. MAIN MEASURES Caregiver Appraisal Scale, SF-36v2 Health Survey, Mayo-Portland Adaptability Inventory-4, Caregiver Questionnaire. RESULTS The majority of caregivers were helping an SMV with mild TBI and comorbid posttraumatic stress disorder/depression, who was injured in a blast-related incident during combat. Caregivers helped predominantly with activities of daily living and/or instrumental activities of daily living and spent more than 40 hours per week providing care. High-support caregivers were more likely to be caring for an SMV with comorbid posttraumatic stress disorder, report poor physical and mental health outcomes, and have a negative impact on employment and finances. CONCLUSIONS A better understanding of protective factors is required to ensure that burden of care does not exceed the caregiver's health and financial capacity, or undermine the care, well-being, and recovery of the SMV.
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Mental health and life satisfaction of individuals with spinal cord injury and their partners 5 years after discharge from first inpatient rehabilitation. Spinal Cord 2018; 56:598-606. [PMID: 29335473 DOI: 10.1038/s41393-017-0053-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To describe and compare mental health and life satisfaction between individuals with spinal cord injury (SCI) and their partners 5 years after discharge from first inpatient rehabilitation; and to examine if injury severity moderates the association between individuals' with SCI and their partners' mental health and life satisfaction. SETTING Dutch community. METHODS Sixty-five individuals with SCI and their partners completed a self-report questionnaire. Main outcome measures were the mental health subscale of the Short-Form Health Survey and the Life Satisfaction Questionnaire. RESULTS Levels of mental health and life satisfaction of individuals with SCI and partners were similar, with median scores of 76 and 4.8 versus 76 and 4.6, respectively. Moderate to strong correlations between individuals with SCI and their partners were found for the mental health (rS = 0.35) and life satisfaction scores (rS = 0.51). These associations were generally stronger in the subgroup of individuals with less severe SCI. Associations between scores on separate life domains ranged from negligible (0.05) to moderate (0.53). Individuals with SCI and their partners were least satisfied with their 'sexual life'. Compared with their partners, individuals with SCI were significantly more satisfied in the domains 'leisure situation', 'partnership relation' and 'family life', and less satisfied in 'self-care ability'. CONCLUSIONS This study showed similarities but also differences in mental health and life satisfaction between individuals with SCI and their partners. In clinical practice, attention on mental health and life satisfaction should, therefore, focus on different domains for individuals with SCI and partners.
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Fekete C, Tough H, Siegrist J, Brinkhof MWG. Health impact of objective burden, subjective burden and positive aspects of caregiving: an observational study among caregivers in Switzerland. BMJ Open 2017; 7:e017369. [PMID: 29275339 PMCID: PMC5770953 DOI: 10.1136/bmjopen-2017-017369] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate associations of objective caregiver burden, subjective caregiver burden and positive aspects of caregiving with self-reported health indicators in caregiving partners of persons with a severe physical disability (spinal cord injury). DESIGN Cross-sectional, observational. SETTING Community, Switzerland. PARTICIPANTS Caregiving partners of persons with spinal cord injury (n=118, response rate 19.7%). OUTCOME MEASURES General health, role limitations due to physical health, role limitations due to mental health, pain intensity, mental health and vitality were assessed using items from the 36-Item Short Form Health Survey (SF-36). Three items were used to assess the frequency of different types of sleep problems. RESULTS Subjective caregiver burden was associated to all self-reported health indicators. A high subjective burden was linked to poorer general health (OR 6.5, 95% CI 2.0 to 21.5), more role limitations due to physical health (OR 4.2, 95% CI 1.4 to 12.8), more role limitations due to mental health (OR 3.6, 95 % CI 1.1 to 11.7), higher pain intensity (OR 4.0, 95% CI 1.4 to 11.5), poorer mental health (coefficient -17.9, 95% CI -24.5 to -11.2), lower vitality (coefficient -20.3, 95% CI -28.4 to -12.1), and more frequent sleep problems (OR 5.3, 95% CI 1.6 to 18.4). Partners who indicated positive aspects of caregiving further reported better mental health (coefficient 6.5, 95% CI 0.2 to 12.8). Objective burden was not related to any health indicator. CONCLUSIONS Subjective burden and lack of positive aspects of caregiving were associated with poorer physical and mental health. Caregiver health may be promoted through the strengthening of psychological and psychosocial resources.
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Affiliation(s)
| | - Hannah Tough
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Johannes Siegrist
- Faculty of Medicine, University of Duesseldorf, Life-Science-Center, Duesseldorf, Germany
| | - Martin WG Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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The impact of spinal cord injury on the quality of life of primary family caregivers: a literature review. Spinal Cord 2017; 55:964-978. [DOI: 10.1038/sc.2017.56] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 11/08/2022]
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Castellano-Tejedor C, Lusilla-Palacios P. A study of burden of care and its correlates among family members supporting relatives and loved ones with traumatic spinal cord injuries. Clin Rehabil 2017. [DOI: 10.1177/0269215517709330] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To understand and describe in a sample of caregivers of persons with spinal cord injury, their burden of care, resilience and life satisfaction and to explore the relationship between these variables. Design: Cross-sectional design. Setting: One Spinal Cord Injury Acute Inpatient Unit from a general hospital. Subjects: Seventy-five relatives of persons with spinal cord injuries (84% women) with a mean age of 48.55 ( SD = 12.55) years. Interventions: None. Measures: Demographics (neurological loss and severity according to the American Spinal Injury Association criteria), the Zarit Burden Interview, the Resilience Scale and the Life Satisfaction Checklist. Results: All caregivers experienced feelings of different intensities of burden (52% mild-to-moderate, 43% moderate-to-severe and 5% severe), and none of them expressed little or no burden at the assessment moment. Caregivers’ main worries were “dependence” and “the future of the injured.” Resilience was medium-to-high (mean = 141.93, SD = 23.44) for the whole sample with just a minority of them revealing low (15%) or very low resilience (7%). The highest scores were obtained in relation to “caregivers’ independence” and “meaning of their lives.” Life satisfaction scores were medium-to-high (mean = 36.6, SD = 6). These scores were not related to demographics or the severity of the injury. Zarit Burden Interview scores were negatively correlated to Resilience Scale ( r = −.370, P = .001) and Life Satisfaction Checklist scores ( r = −.412, P < .001). Conclusion: More resilient and satisfied caregivers experienced lower burden. Burden is moderate-to-high and mainly related to uncertainty about the future, caregivers’ insecurity with caregiving and dependence of the injured.
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Affiliation(s)
- Carmina Castellano-Tejedor
- Department of Psychiatry, University Hospital Vall d’Hebron, Autonomous University of Barcelona, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Pilar Lusilla-Palacios
- Department of Psychiatry, University Hospital Vall d’Hebron, Autonomous University of Barcelona, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
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